Malnutrition and inflammation in hemodialysis patients: Comparative evaluation of neutrophil reactive oxygen formation

Cohen-Hagai, Keren; Nacasch, Naomi; Sternschuss, Aviad; Ohana, Meital; Wolach, Baruch; Benchetrit, Sydney; Gavrieli, Ronit; Zitman‐Gal, Tali

doi:10.1016/j.nut.2020.110793

Cited by 10 publications

(11 citation statements)

References 26 publications

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“…In a recent observational study conducted by Wang et al, higher MIS was associated with higher IL-6 levels [ 31 ]. Moreover, in a study by Keren et al, malnutrition, evaluated by MIS, was associated with higher CRP levels, and both malnutrition and inflammation were associated with dysfunctional neutrophils’ phagocytic activity, thus impairing immunity and favoring the maintenance of inflammation [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

In Patients with Chronic Kidney Disease Advanced Glycation End-Products Receptors Isoforms (sRAGE and esRAGE) Are Associated with Malnutrition

et al. 2022

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Background: in patients with chronic kidney disease (CKD), the inflammatory and pro-oxidant milieu may contribute to malnutrition development. In this study, we investigated the relationship between inflammation, advanced glycation end-products (AGEs), and their receptors (RAGEs) with malnutrition in CKD patients. Methods: we evaluated 117 patients. AGEs were quantified by fluorescence intensity using a fluorescence spectrophotometer, soluble RAGEs isoforms, and inflammatory interleukins by ELISA. Malnutrition was assessed by a malnutrition inflammation score. Results: mean age was 80 ± +11 years, eGFR was 25 ± +11 mL/min/1.73 m2 and BMI was 28 ± 5 Kg/m2. Malnourished individuals were older, had lower estimated protein intake (nPCR 0.65 ± 0.2 vs. 0.8 ± 0.2 vs. 0.8 ± 0.3, p = 0.01), higher C reactive protein (CRP 0.6 ± 1 vs. 0.6 ± 0.7 vs. 0.17 ± 0.13, p = 0.02) and tumor necrosis factor α (TNF α 14.7 ± 8.7 vs. 15.6 ± 8 vs. 11.8 ± 5.8, p = 0.029). Malnourished patients had higher sRAGE (2813 ± 1477 vs. 2158 ± 1236 vs. 2314 ± 1115, p = 0.035) and esRAGE (648 [408–1049] vs. 476 [355–680] vs. 545 [380–730] p = 0.033). In the multivariate analysis, only sRAGE maintained its association with malnutrition (p = 0.02) independently of aging and inflammation. Conclusions: in CKD patients, RAGEs isoforms, but not AGEs, are associated with malnutrition, irrespective of systemic inflammation, aging, and renal function.

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Section: Discussionmentioning

confidence: 99%

In Patients with Chronic Kidney Disease Advanced Glycation End-Products Receptors Isoforms (sRAGE and esRAGE) Are Associated with Malnutrition

et al. 2022

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“…Absolute lymphocyte count and dialysis adequacy were also positively correlated with HBsAb titers. These findings, in addition to the growing evidence that nutritional status has a fundamental role in the outcome of MHD patients, specifically suggest a role in the complex immune response to vaccine [ 1 , 27 , 28 , 29 ]. This finding has clinical significance.…”

Section: Discussionmentioning

confidence: 89%

Humoral Response to Hepatitis B and COVID-19 Vaccine among Maintenance Hemodialysis Patients

et al. 2022

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Maintenance hemodialysis (MHD) patients have impaired immunological responses to pathogens and vaccines. In this study, we compared the humoral response to HBV and COVID-19 vaccines in a cohort of MHD patients. Demographic and clinical characteristics of vaccine responders and non-responders were also compared, and the association between the humoral responses to both vaccines was evaluated. The cohort included 94 MHD patients who were vaccinated at least once for HBV and twice for COVID-19. Among the 94 patients, 28 (29.8%) did not develop protective titers to HBV. Hypertension, coronary heart disease, and heart failure were more common in non-responders. Among MHD patients, 85% had positive IgG anti-spike SARS-CoV-2 levels 6 months after two doses of BNT162b2 (Pfizer/Biotech) vaccine. Age and immunosuppressive therapy were the main predictors of humoral response to COVID-19 vaccine. We did not find any association between non-responders to HBV and non-responders to COVID-19 vaccine. There was no difference in IgG anti-spike titers between HBV responders and non-responders (505 ± 644 vs. 504 ± 781, p = 0.9) Our results suggest that reduced humoral response to hepatitis B is not associated with reduced response to COVID-19 vaccine. Different risk-factors were associated with poor immune response to HBV and to COVID-19 vaccines.

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“…We recently reported that phagocyte activity in MHD patients is impaired, especially among malnourished patients 27 . All 44 MHD patients included in that study had reduced MFI‐ E. coli levels; although, malnourished patients demonstrated reduced MFI‐PMA levels compared to patients with better nutritional status 27 .…”

Section: Discussionmentioning

confidence: 95%

Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes

Mudrik-Zohar

Alon

Nacasch

et al. 2023

Seminars in Dialysis

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IntroductionPatients with end stage kidney disease undergoing maintenance hemodialysis (MHD) are prone to malnutrition and infections.ObjectiveThe objective of this study was to evaluate the effect of polymorphonuclear (PMN) cell dysfunction on clinical outcomes of MHD patients, in association with nutritional status.MethodsThis prospective study investigated 39 MHD patients by evaluating the oxidative activity of their PMN cells using Phorbol 12‐Myristate‐13‐Acetate (PMA) stimulation. Blood samples were taken from each participant at dialysis initiation. Demographics, laboratory data, and clinical outcomes during a 24‐month follow‐up period were obtained from electronic medical records.ResultsPhagocytic activity was described in percentiles of mean fluorescence intensity (MFI) of PMA levels. There were no differences in comorbidities between patients with low or high MFI‐PMA percentiles. Patients in the lowest (25th) MFI‐PMA percentile (N = 10) had poorer nutritional status and more frequent severe infections compared to the other 29 patients (4.3 ± 3.4 events versus 2 ± 2.2 events, p = 0.017). Furthermore, they had more frequent hospitalizations (>3) due to infections (70% versus 41%, p = 0.073) and their mortality rate was higher (80% versus 31%, p = 0.007). The odds ratio for all‐cause mortality was 8.85. In multivariate analysis, the MFI‐PMA percentile and ischemic heart disease were the strongest predictors of all‐cause mortality (p = 0.02 and p = 0.005, respectively).ConclusionsLow MFI‐PMA levels were associated with poor nutritional status and adverse clinical outcomes and might serve as a prognostic biomarker, predicting severe infections and mortality among malnourished MHD patients.

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Malnutrition and inflammation in hemodialysis patients: Comparative evaluation of neutrophil reactive oxygen formation

Cited by 10 publications

References 26 publications

In Patients with Chronic Kidney Disease Advanced Glycation End-Products Receptors Isoforms (sRAGE and esRAGE) Are Associated with Malnutrition

In Patients with Chronic Kidney Disease Advanced Glycation End-Products Receptors Isoforms (sRAGE and esRAGE) Are Associated with Malnutrition

Humoral Response to Hepatitis B and COVID-19 Vaccine among Maintenance Hemodialysis Patients

Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes

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